Healthcare Provider Details

I. General information

NPI: 1790234326
Provider Name (Legal Business Name): RACHEL BOATMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 UNION DR
AMES IA
50011-2029
US

IV. Provider business mailing address

2647 UNION DR
AMES IA
50011-2029
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-7265
  • Fax: 515-294-1190
Mailing address:
  • Phone: 515-294-7265
  • Fax: 515-294-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberG132358
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: